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I. Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,this may reduce the amount of tax due or result in a tax refund.The tax year is from July 1 to June 30. •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurred,whichever is later. •File your application with the county tax collector of the county in which your damaged property is located. Applicant's name •e✓6 i /cJu,✓i7�i[�slti Phone � f----e( r�r So 3 �G ;/-� y 7Z� Mailing addrerEmail(optional) ADO. 5/6 d b.b FH r¢-,� & irr,�c,C•a"- C `/ St�l ZIP code ''' �j ` CSS / q 7 .o - Location and description of damaged or destroyed property Assessor's account number 541325 / R41325 Location of property(if different from above) Section Township Range Tax lot number 10025 North Fork Ln SE 02DC 09S 3E 1100 Description of personal property Lyons, OR 97358 Date of i Cause of damage fad >ire(attach fire department report) 0 Act of God(describe): Dania occurred to Ind C./Building fa.logrsonal property 0 Manufactured structure Describe damage �j Q l///��IP - // Gl /'/�Po� �d G� /�DLe/�l pg Po N 8u. o W eq U � C4 ZC) Application for proration of tax ccLU c c d ❑I am applying to have the above roe 7` PPM 9 property rty examined for proration of property taxes per ORS 308.425.Application must be submitted within 60 days of damage or June 30,whichever is later. Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my property is only dam- aged,I must notify the tax collector of the date that the damage is repaired.Such notice will serve to inform the tax collector of their duty to calculate and finalize the tax proration. Declaration I declare under the penalties for false swearing[ORS 305.990(4)]that I have examined this document and to the best of my knowledge it is true, rest,and complete. -26446- Applicant's signature �! / 7( �O Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: Cleric Date received: Clerk: Damaged property: This year Land and improvements: Date rebuild complete: '"�� Months prorated: �� Real market value(RM before RMV after / � fire/act of God: fire/act of God: / Assessed value(AV) fore Value /y,�/A Amount of adjustment/refund: , .r fire/act of God: ' ,SM percent of loss: V Destroyed property: 9 This year Personal property: WW Months prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/milord: — 3 S 9'S g fire/act of God: percent of loss: RemRemarks: Date property visited: 0 Damaged a � /4447( Destroyed i